When a treatment plan involves the loss of a front tooth and implant replacement, many factors need to be critically assessed. One factor is the soft tissue response to implant and restorative treatment. Studies show that 1-2 years after placement of a maxillary anterior implant restoration, recession frequently occurs. It occurs for many reasons, some of which are:
- A thin periodontium
- Soft tissues only adhere to titanium or zirconium, they do not insert like sharpey’s fibers into a tooth
- Constantly removing and replacing implant components can cause attachment loss
- Over-contoured abutments or restorations
A subepithelial connective tissue graft will thicken the periodontium, widen the zone of attached gingiva and reduce the risk of recession. When planning an esthetic implant reconstruction, soft tissue grafting is often incorporated into the surgical treatment plan. Although this results in more treatment steps and associated costs, it leads to a much more predictable and stable long-term esthetic restoration.
In the case below, a patient presented with an implant restoration performed less than one year ago. The photo shows significant recession, the titanium abutment is clearly visible. The implant emergence is fine (just buccal to the incisal edge), but the abutment had a very strong emergence profile (stock abutment). The periodontium was also thin and the crown was ill-fitting. With a properly contoured screw retained composite provisional, and two surgical procedures (connective tissue grafts), the proper soft tissue profile was restored.
